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Journal article

Doctors within borders: meeting the health care needs of migrant farm workers in Canada




Michael Pysklywec , Janet McLaughlin, Tew Michelle, and Haines Ted


José, a migrant farm worker from Mexico, presents with a one-month history of low back pain. Through broken English and Spanish, he
tells you that he has been in Canada for three months working on an asparagus farm. For the past six weeks, he has been spending 10 hours
per day, six days per week, bent over cutting asparagus spears. José’s boss has his health card. Because José is only in town every Friday night
to shop for groceries, he is not available when the radiology clinic and laboratory are open. Recognizing that his condition is related to his
work, you wonder about filing a claim with the Workers’ Compensation Board. José has difficulty understanding what this means, but
clearly does not want his employer to know that he has a sore back. He simply wants pills to help ease the pain. He is unsure of whether he
has insurance coverage for medications and wants the least expensive medicine. You write out instructions for an over-the-counter antiinflammatory medication and direct him to a pharmacy. This patient’s unique circumstances have raised a number of unanswered questions.

Journal title

Canadian Medical Association Journal (CMAJ)



Page numbers





Health issues in migrant farm
workers in Canada and the United States5–18
• Musculoskeletal
- Injuries
- Pain in back, neck, knee, shoulders,
hands or feet
• Ocular
- Conjunctivitis
- Corneal foreign bodies and abrasions
- Pterygia
• Dermatologic
- Contact dermatitis
- Folliculitis
- Tinea
• Psychological
- Depression
- Anxiety
- Inconsistent sleep patterns
• Sexual and reproductive
- Sexually transmitted infections
(e.g. urethritis)
- HIV infection (p.2)

35% of visits to the clinic by migrant workers were for musculoskeletal problems relating to their work. Ocular issues (13% of visits) and skin
issues (6%) were also very common (p.2)

First, clinicians should strive to be aware of and sensitive to the unique needs, circumstances and vulnerabilities of migrant workers, and to adapt their practices accordingly. For example, physicians could schedule clinic hours to coincide with times in which workers are likely to be in town, or arrange with employers for access to the workers during regular hours. Given the limited job alternatives for migrant workers and the precarious nature of their employment in Canada, clinicians may need to be flexible or creative with treatment-related work restrictions. Clinics could also develop interpretation services that are independent
from workers’ employers .
In addition, it is helpful to maintain clinical vigilance for common health issues in this group, in recognition of the heavy physical demands of farm labour and the potential for symptoms of irritation
from pesticide exposure and other hazards. Finally, clinicians could engage in discussions with local health agencies to consider additional or alternative models of health care delivery. (p4).

File Attachments


Economic sectors

Agriculture and horticulture workers, General farm workers, and Harvesting labourers

Content types

Policy analysis and Documented cases of abuse

Target groups

Public awareness and Researchers

Geographical focuses

Ontario, Federal, and National relevance

Spheres of activity

Health sciences